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Two from Two Years Ago: Medicaid and Women's Health

Debates on Texas Medicaid financing and the Texas Women’s Health Program will dominate the health care arena in the coming weeks.

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With barely a foot in the door, legislators are already scurrying around the Capitol to make a deal to keep Medicaid afloat. Meanwhile, down the street at the Travis County District courthouse, the state’s lawyers are attempting to drown out Planned Parenthood’s arguments that the organization shouldn’t be excluded from the Texas Women’s Health Program.

“This is a must-pass issue, and we have to deal with it swiftly. We have until March to push this through,” said Sen. Jane Nelson, R-Flower Mound and chair of the Senate Health and Human Services Committee, in an email on the need for a Medicaid supplemental financing bill.

Based on current cost trends, the Health and Human Services Commission must receive $4.7 billion to continue financing Medicaid by March “to avoid cash flow issues,” said Stephanie Goodman, a spokeswoman for the agency.

Lt. Gov. David Dewhurst said that the Senate plans to present a $5.2 billion supplemental bill — including $4.5 billion to fund Medicaid — to cover unsupported spending in the 2012-13 biennium budget next week. That would eat up the majority of the $8.8 billion ending balance the state comptroller forecast for the 2012-13 biennium budget. 

The supplemental bill “will cover the six months of Medicaid funding which we didn’t pay for in 2011,” said Dewhurst, “…which in retrospect was a wise decision because we were able to realize $2 billion in savings that we would not be able to realize otherwise.”

In the last two years, the agency saved $1.1 billion by expanding Medicaid managed care statewide and $955 million in general revenue from other cost containment initiatives approved during the 2011 legislative session, according to a consolidated budget report presented to Texas lawmakers.

Dewhurst’s comment was made under the assumption that by not fully financing Medicaid, those reforms were more effective, because there was added pressure on the agency to save money.

Developments in the state’s ongoing legal battle with Planned Parenthood could also impact lawmaker’s plans in the coming weeks for legislation regarding the state-funded Texas Women’s Health Program, which replaced the joint state-federal Medicaid Women’s Health Program in January. The federal government cut off its share of funding for the Medicaid WHP in response to the state’s efforts to implement the Affiliate Ban Rule, which prohibits providers affiliated with abortion providers from participating in the program. 

Planned Parenthood has filed multiple lawsuits seeking to overturn the state’s Affiliate Ban Rule. At a hearing in Travis County Court on Friday, Planned Parenthood will ask for a temporary injunction to be included in the state’s family planning program for low-income women until a full trial can be held. The organization is also asking the court to overturn a “poison pill” rule created by the Department of State Health Services, which runs the Texas Women’s Health Program, that would force the state to shut down the program if a court overturned the Affiliate Ban Rule.

Planned Parenthood previously argued in court that a state agency does not have the authority to establish such a rule. “That is the kind of drastic action that you have to have statutory authority for and they don’t,” said Pete Schenkkan, a lawyer representing Planned Parenthood at a hearing in December.

Lawmakers considered adding the “poison pill” provision to the law establishing the Affiliate Ban Rule that passed in 2011, but the measure was ultimately not included. While Rep. Lon Burnam, D-Fort Worth, has already filed a bill to overturn the Affiliate Ban Rule in support of Planned Parenthood, Republicans in favor of excluding the organization from the Texas Women’s Health Program may consider adding stricter statutes to ensure Planned Parenthood’s court pursuits are not successful.

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83rd Legislative Session Medicaid Women's Health Program